Massimo Martinelli1, Francesca Paola Giugliano1, Caterina Strisciuglio2, Vaidotas Urbonas3, Daniela Elena Serban4, Aleksandra Banaszkiewicz5, Amit Assa6, Iva Hojsak7, Tereza Lerchova8, Víctor Manuel Navas-López9, Claudio Romano10, Małgorzata Sladek11, Gabor Veres12, Marina Aloi13, Ruta Kucinskiene14, Erasmo Miele1. 1. Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II," Napoli, Italy; Napoli, Italy. 2. Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli," Napoli, Italy. 3. Vilnius University Clinic of Children's Diseases, Vilnius, Lithuania. 4. 2nd Department of Pediatrics, 'Iuliu Hatieganu' University of Medicine and Pharmacy, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania. 5. Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland. 6. Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach-Tikva, affiliated with the Sackler faculty of Medicine, Tel-Aviv University, Israel. 7. Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, University J.J. Strossmayer, Osijek, Croatia. 8. Pediatric Department of 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic. 9. Pediatric Gastroenterology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain. 10. Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy. 11. Department of Pediatrics, Gastroenterology and Nutrition Jagiellonian University Medical College, Kracow, Poland. 12. Pediatric Institute, AOK, University of Debrecen, Debrecen, Hungary. 13. Department of Pediatrics, Sapienza University, Rome, Italy. 14. Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Abstract
BACKGROUND: Vaccine-preventable diseases and opportunistic infections in pediatric inflammatory bowel disease (IBD) are increasingly recognized issues. The aims of this study were to evaluate vaccinations, immunization status, and consequent therapeutic management in children with IBD and to analyze the differences among patients diagnosed before (Group 1) and after June 2012 (Group 2). METHODS: This was a multicenter, retrospective cohort investigation. Between July 2016 and July 2017, 430 children with IBD were enrolled in 13 centers. Diagnosis, therapeutic history, vaccinations, and immunization status screening at diagnosis and at immunosuppressant (IM)/biologic initiation and reasons for incomplete immunization were retrieved. RESULTS: Vaccination rates at diagnosis were unsatisfactory for measles, mumps, and rubella (89.3%), Haemophilus influenzae (81.9%), meningococcus C (23.5%), chickenpox (18.4%), pneumococcus (18.6%), papillomavirus (5.9%), and rotavirus (1.9%). Complete immunization was recorded in 38/430 (8.8%) children, but specific vaccines were recommended in 79/430 patients (18.6%), without differences between the 2 groups. At IM start, 22% of children were tested for Epstein-Barr virus (EBV) status, with 96.2% of EBV-naïve patients starting azathioprine, without differences between Groups 1 and 2. Screening for latent tuberculosis (TB) before start of biologics was performed in 175/190 (92.1%), with up to 9 different screening strategies and numerous inconsistencies. CONCLUSIONS: We demonstrated a poor immunization status at diagnosis in children with IBD, which was not followed by proper vaccination catch-up. EBV status before IM initiation and latent TB before biologics were not adequately assessed. Thus, the overall impact of the current guidelines seems unsatisfactory.
BACKGROUND: Vaccine-preventable diseases and opportunistic infections in pediatric inflammatory bowel disease (IBD) are increasingly recognized issues. The aims of this study were to evaluate vaccinations, immunization status, and consequent therapeutic management in children with IBD and to analyze the differences among patients diagnosed before (Group 1) and after June 2012 (Group 2). METHODS: This was a multicenter, retrospective cohort investigation. Between July 2016 and July 2017, 430 children with IBD were enrolled in 13 centers. Diagnosis, therapeutic history, vaccinations, and immunization status screening at diagnosis and at immunosuppressant (IM)/biologic initiation and reasons for incomplete immunization were retrieved. RESULTS: Vaccination rates at diagnosis were unsatisfactory for measles, mumps, and rubella (89.3%), Haemophilus influenzae (81.9%), meningococcus C (23.5%), chickenpox (18.4%), pneumococcus (18.6%), papillomavirus (5.9%), and rotavirus (1.9%). Complete immunization was recorded in 38/430 (8.8%) children, but specific vaccines were recommended in 79/430 patients (18.6%), without differences between the 2 groups. At IM start, 22% of children were tested for Epstein-Barr virus (EBV) status, with 96.2% of EBV-naïve patients starting azathioprine, without differences between Groups 1 and 2. Screening for latent tuberculosis (TB) before start of biologics was performed in 175/190 (92.1%), with up to 9 different screening strategies and numerous inconsistencies. CONCLUSIONS: We demonstrated a poor immunization status at diagnosis in children with IBD, which was not followed by proper vaccination catch-up. EBV status before IM initiation and latent TB before biologics were not adequately assessed. Thus, the overall impact of the current guidelines seems unsatisfactory.
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